Youth Support Group 2022 Registration
Our Youth Support Group aims to provide a supportive, understanding and non-judgemental environment for youth with epilepsy, to connect with their peers, share lived experiences and learn new strategies to support them in their journey with Epilepsy. This program is geared for youth between the ages of 14 -17 and will be held quarterly at 1:00PM - 2:15PM on the following dates: March 27, May 29, September 25 and November 27. Please register using this form, and email katie@epilepsytoronto.org if you have any questions. (Please note, all new families to Epilepsy Toronto will require an initial intake appointment after registration).
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Name of Youth *
Youth's Date of Birth *
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Youth's cell phone number (if they don't have one, write N/A) *
Youth's email contact (if they do not have one, please list parent's email) *
Youth's home address *
Emergency contact's name and relation *
Emergency contact's phone number *
Emergency contact's email *
Please provide a brief description on the youth's seizures to have on file (seizure types, typical length, frequency, triggers, last seizure occurrence etc). Include anything you feel is important for us to know, while group is in session. *
What would you like us to do in case of a seizure event, while participating in virtual group? *
Accessibility needs: Is there anything else you'd like staff to know, be aware of, or ways we can support the participating youth during the support group?
Are there any specific goals the youth has for participating in this group?
Are there any specific goals the parent/caregiver has for their youth participating in this group?
How did you hear of this group program? *
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